i.

Problem
Hearing Impairment

ii. Intervention
 Asses the level of hearing impairment of the patient (mild, moderate, severe).
 Emphasize to patient the importance of routine examination. Frequent
examinations detect changes in hearing or need for change in hearing aid.
 Instruct patient or caregiver in safe techniques for cleaning ears.
 Provide conducive environment (calm and quiet). 
 Phrase questions to be answered simply by yes or no, to reduce the confusion in
patient to process a lot of information.
 Speak in normal tones and avoid talking too fast. Avoid pressing for response.
Pressing for response may result in frustration in patient. 
 Teach patient or caregiver to use and care of the hearing aid or other assistive
hearing devices.

iii. Basic nursing responsibility

 Asses patient’s ability to hear to determine the severity of the hearing impairment
as a baseline data for further intervention.
 Minimize environmental noise when giving the information to the patient to
encourage effective communication between the nurse and the patient. 
 Teach patient or caregiver to administer ear medications by showing the position
of the head to allow the medication flow into the ear canal (in case of hard
cerumen or infection).
 Communicate using clear and simple word to ensure patient can understand and
interpret the message. Long sentences may cause the patient to misinterpret the
message.
 Provide alternative methods of communication: pen, paper, pictures.
 Assist patient to choose the best hearing aids according to the severity of the
condition to help the patient to have a better life style in communicating with the
people around.
 Encourage family members to use the alternative methods in communication with
the patient and take part in the activities. 

i. Problem
Memory Problems

ii. Intervention
 When assessing an adult patient with a previously diagnosed cognitive
impairment, there are several assessments to include on admission. Their
medical history should be reviewed and a medication reconciliation completed. A
comprehensive neurological assessment should be performed to establish a
patient’s baseline neurological status. After a baseline status is determined,
routine focused neurological assessments are performed to monitor for changes,
such as asking the patient to state their name, place, and the date, as
appropriate.
 Cognitive changes including disorientation, poor judgment, loss of language skill,
and memory impairment should be assessed objectively using standardized
tools.
  Additional assessments include functional status and the patient’s ability to
perform activities of daily living (ADLs). A decline in the ability to perform self-
care and maintain ADLs can affect the individual’s well-being. Functional
declines can bring about feelings of inadequacy and lead to depression. The
ability to live independently relies on maintenance of self-care skills.
 Allow elderly opportunities to share their past experiences and stories. This
allows expression of personal identity and supports the individual’s coping and
self-esteem.
 Reality Orientation: This technique provides awareness of person, place, and
time for those who are cognitively able. It restores a sense of reality, decreases
confusion and disorientation, and promotes a healing environment.
 Validation Therapy: This technique is used for older adults who are confused.
The focus is on the emotional aspect of their communication. This therapy avoids
reorientation to time and place, even when incorrect. It does not reinforce
incorrect perception but focuses on validating their feelings.

iii. Basic nursing responsibility

 Orient patient to reality as needed:
 Call the patient by name
 Telling the patient your name
 Provide background information, like time, place, and date
 Orient patient to his environment
 Check the ability to send, receive, and interpret information.
 Protect the patient from sensory overload and allow for frequent rest periods.
 Provide environmental adaptations to support cognitive function and safety;
consider sensory exposure, hearing ability and distractions.
 Enforce with positive feedback. Give positive feedback when thinking and
behavior are appropriate, or when client verbalizes that certain ideas expressed
are not based in reality. Positive feedback increases self-esteem and enhances
desire to repeat appropriate behavior.
 Encourage multimodal physical activity, exercise and complementary
interventions, such as mind-body exercise; consider combined exercise and
cognitive activity.